Chronic gout is gout that continues to produce signs and symptoms, such as gout flares, due to ongoing gout crystal deposits.

If you take conventional uric acid–lowering medicine and have more than 1 gout flare a year—or at least 1 visible lump (tophus) on your body—your gout may be uncontrolled. See what can happen when gout is uncontrolled.

If you take oral gout medicine and still experience gout symptoms, your gout may be uncontrolled. Your flares may also become more frequent and severe or occur in other joints, or you may develop visible lumps of uric acid crystal buildup (tophi). Take a short quiz.

In addition to more frequent and severe gout flares, uric acid crystals can build up in other places in your body, even in places you can’t see. This means damage can happen in areas where you never had a flare.

Gout is caused by too much uric acid in your blood. It’s rarely caused by diet, though certain foods can trigger a gout attack. Over time, uric acid crystals can form and settle in your joints. If gout remains uncontrolled, it could lead to permanent joint and bone damage.

Uric acid is produced when your body breaks down purines found naturally in your body and in certain foods.
Normally, uric acid dissolves in your blood and is removed through your kidneys. Even healthy kidneys only get rid of about 10% of the uric acid
they process. Kidney disease can make it even more difficult to get rid of uric acid. However, if you produce too much uric acid, or remove too little, the uric acid can form into tiny needle-like crystals that settle in your joints and surrounding tissues. KRYSTEXXA works differently to lower your uric acid level and help resolve tophi that form when uric acid crystals build up.

Many people who have kidney disease can develop gout because diseased kidneys have a harder time removing uric acid from the blood. When too much uric acid builds up, uric acid crystals start to form, settle in joints, and cause painful gout attacks. Finding a medication that can lower your uric acid level is important.

About 1 in 4 people with moderate-to-severe kidney disease also has gout. When you have chronic kidney disease, your kidneys don’t work as well as they should to remove uric acid from the body. Too much uric acid in your blood can cause gout.

If you are taking oral medicines for gout, and still having flares or pain and swelling in your hands, feet, or other joints, that may be a sign that your gout is uncontrolled. Ask your nephrologist if a blood test to measure your uric acid levels is an option for you. If oral gout medicines are not doing enough to control your gout, ask your nephrologist about KRYSTEXXA.

Oral gout medications may be enough to control gout. But, if gout is uncontrolled, the medicine may not lower your uric acid level enough to stop gout symptoms. Over the years, uric acid builds up in your blood and can form crystals. This can cause complications in the joints and organs like your kidneys.*

*KRYSTEXXA has not been studied to remove urate deposition from any of the body's organs.

If you are taking an oral medication for your uncontrolled gout and are still experiencing more than 1 flare or the presence of tophi in the last 12 months, it might be time to try another treatment option. Talk to your nephrologist or doctor to get more information.

KRYSTEXXA was tested in patients with mild to moderate chronic kidney disease . It has been shown to be effective and has a proven safety profile.

When uric acid crystals build up in your joints you can develop gout flares. Gout flares cause inflammation, redness, swelling, tenderness, and intense pain. Visible lumps called tophi can also form. Your doctor will test your uric acid level to determine whether or not your signs and symptoms are the result of gout.

Over time, uric acid crystals can accumulate in new areas of your body, causing you to experience flares and damage in more places. That’s one sign your gout is uncontrolled.

Tophi (TOE-f-EYE) are hard lumps of uric acid crystals that build up so much they become visible. The big toe is a common place to develop tophi. They can also form in other areas of the body like your hands, elbows, and knees. Anyone with gout is at risk of developing tophi if gout stays uncontrolled for too long.

Even when you’re not having a flare, you still have the underlying condition that causes gout. Take control of chronic gout by dissolving uric acid crystal buildup and keeping your uric acid level low enough to prevent new buildup.

Once your joints and bones are damaged, it’s permanent. The risk of joint and bone damage increases as gout builds up in your joints.

Your doctor may prescribe an oral medicine called methotrexate to take with KRYSTEXXA to help reduce symptoms of uncontrolled gout.

Studies show:

• Patients who took KRYSTEXXA with methotrexate saw the best results at 6 to 12 months of treatment.^†
• Patients who took KRYSTEXXA with methotrexate had more reductions in tophi compared to those who used KRYSTEXXA alone at Month 12.
• KRYSTEXXA works better with methotrexate to reduce infusion reactions so you can stay on treatment longer, which helps lower uric acid levels more effectively.

^†Optimal treatment duration has not been established.

Methotrexate improves the way KRYSTEXXA works.

Yes. If you and your doctor determine methotrexate is not right for you, KRYSTEXXA is effective when used alone.

KRYSTEXXA is a delicate enzyme that would be destroyed in your stomach if taken as a pill.

Since KRYSTEXXA is an IV treatment that’s delivered directly into your bloodstream, it has to be given to you by a nurse or other trained professional. Some doctors do it in their offices. If yours does not, you can go to an IV treatment center or hospital.

Learn more about how KRYSTEXXA works with a medication called methotrexate.

While taking KRYSTEXXA, do not take any other uric acid–lowering drugs, such as Zyloprim^® (allopurinol) or Uloric^® (febuxostat). Your doctor or gout specialist may give you medicine (colchicine and/or NSAIDs) to help with any gout flares you may have while on KRYSTEXXA. In preparation for your KRYSTEXXA IV treatment, your doctor may also give you antihistamines and corticosteroids.

Your doctor will determine if methotrexate is right for you based on your medical information. Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Do not take any other uric acid lowering drug, such as allopurinol, febuxostat (Uloric^®), or probenecid, while receiving KRYSTEXXA.

In clinical studies, the best results were seen after 6 to 12 months of treatment. KRYSTEXXA starts working within 24 hours.

The ideal length of treatment with KRYSTEXXA has not been determined.

Not necessarily. KRYSTEXXA works well alone to lower uric acid levels in the blood as soon as 24 hours after the first IV treatment. However, some medicines, like KRYSTEXXA, may cause your immune system to overreact in response to them and create antidrug antibodies (ADAs), which can stop KRYSTEXXA from working. The use of methotrexate can help prevent ADAs from forming and allow you to continue your course of treatment.

You and your doctor will decide on a plan to keep uric acid crystals from building up again.

If you and your doctor decide that KRYSTEXXA with methotrexate is an appropriate treatment, 4 weeks prior to starting KRYSTEXXA your doctor will prescribe

• Folic acid to be taken daily by mouth
• Methotrexate to be taken once a week by mouth

Once your KRYSTEXXA IV treatments begin, they will continue every 2 weeks for a length of time your doctor determines.

Yes. People in the clinical studies had the best results when they were given KRYSTEXXA every 2 weeks for 6 to 12 months.^§ It’s important to finish all your treatments as directed by your doctor.

^§Best results were seen after 6 to 12 months of treatment. Optimal treatment duration has not been established.

Making time for your IV treatments can be challenging, but in order to see the best results with KRYSTEXXA, it’s important to receive your IV treatment every 2 weeks. If you are going to miss an appointment, contact your doctor or gout specialist as soon as possible to reschedule.

Methotrexate can be taken with KRYSTEXXA until your KRYSTEXXA treatment is complete. If during treatment you and your doctor determine methotrexate is not right for you, KRYSTEXXA is effective when taken alone.

Best results were seen within 6-12 months, however, optimal treatment duration has not been established with KRYSTEXXA.

With KRYSTEXXA, gout flares are a common side effect, but many people in the clinical studies said they were having fewer flares by the end of treatment. Your doctor may give you medicine (colchicine and/or NSAIDs) to help with any gout flares you may have while on KRYSTEXXA.

The most common side effects of KRYSTEXXA when given with methotrexate were gout flares, joint pain, coronavirus disease 2019 (COVID-19), nausea, and fatigue.

A nurse or assistant will be with you to ensure any infusion reactions are treated. In the clinical studies, all infusion reactions, including serious infusion reactions, were treated at the IV treatment center with medicine or by stopping the IV treatment. Most were resolved using common medications such as Benadryl^®.